SpO_(2)/FiO_(2)预测伴急性呼吸衰竭的间质性肺疾病患者预后的临床价值  

Value of SpO_(2)/FiO_(2)in predicting the prognosis of acute respiratory failure combined with interstitial lung disease

作　　者：张露 孟晓 奚斌 刘文文 张毛为 孙宜田 张灿堂 刘文静 刘启明[2] 陈碧 Zhang Lu;Meng Xiao;Xi Bin;Liu Wenwen;Zhang Maowei;Sun Yitian;Zhang Cantang;Liu Wenjing;Liu Qiming;Chen Bi(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China;Department of Respiratory and Critical Care Medicine,Suining County People's Hospital,Xuzhou 221225,China)

机构地区：[1]徐州医科大学附属医院呼吸与危重症医学科,徐州221006 [2]睢宁县人民医院呼吸与危重症医学科,徐州221225

出　　处：《国际呼吸杂志》2024年第10期1211-1219,共9页International Journal of Respiration

基　　金：江苏省高校重点实验室开放课题(XZSYSKF2022004);江苏省卫生健康委科研项目(H2023005);彭城英才重点人才培养项目(XWRCHT20220063);徐州市科技项目(KC22269)。

摘　　要：目的探讨脉搏血氧饱和度(SpO_(2))/吸入氧浓度(FiO_(2))评估伴急性呼吸衰竭的间质性肺疾病(ILD)患者预后的临床价值。方法本研究为队列研究。采用非随机抽样的方法纳入2022年2月至2023年11月于徐州医科大学附属医院呼吸重症监护室住院治疗的101例伴急性呼吸衰竭的ILD患者。根据随访患者28 d的生存状态,将其分为死亡组(60例)和存活组(41例)。比较2组患者的一般资料、临床资料和SpO_(2)/FiO_(2)、动脉血氧分压(PaO_(2))/FiO_(2)、急性生理与慢性健康(APACHE)Ⅱ评分。采用Spearman相关性分析对SpO_(2)/FiO_(2)、PaO_(2)/FiO_(2)两者之间的关系进行分析。绘制伴急性呼吸衰竭的ILD患者死亡风险的受试者操作特征曲线,比较SpO_(2)/FiO_(2)、PaO_(2)/FiO_(2)、APACHEⅡ评分的诊断效能。多因素Cox回归分析影响伴急性呼吸衰竭的ILD患者预后不佳的影响因素。应用Kaplan-Meier生存分析绘制不同SpO_(2)/FiO_(2)水平的伴急性呼吸衰竭的ILD患者生存曲线,Log-rank检验比较患者预后。结果死亡组中男41例,女19例,年龄71.0(64.0,79.0)岁;存活组中男22例,女19例,年龄70.0(63.5,81.5)岁。死亡组SpO_(2)/FiO_(2)、PaO_(2)/FiO_(2)均低于存活组[(160.07±59.60)比(224.05±63.13)、137.00(106.50,201.75)mmHg(1 mmHg=0.133 kPa)比206.00(155.00,253.50)mmHg],差异均有统计学意义(均P<0.001);死亡组APACHEⅡ评分高于存活组[(19.18±5.85)分比(14.56±3.69)分],差异有统计学意义(P<0.001)。SpO_(2)/FiO_(2)和PaO_(2)/FiO_(2)两者线性相关(r=0.712,P<0.001),线性回归方程:SpO_(2)/FiO_(2)=65.662+0.692×PaO_(2)/FiO_(2)。SpO_(2)/FiO_(2)、PaO_(2)/FiO_(2)、APACHEⅡ评分预测伴急性呼吸衰竭的ILD患者死亡风险的曲线下面积分别为0.779(95%CI:0.684~0.873)、0.722(95%CI:0.623~0.821)、0.755(95%CI:0.661~0.849)。多因素Cox回归分析显示,SpO_(2)/FiO_(2)<214.50(HR=6.180,95%CI:2.407~15.867)、乳酸脱氢酶>290.50 U/L(HR=4.258,95%CI:1.735~10.450)、白蛋白<31.25 g/L(HR=2ObjectiveTo investigate the clinical value of pulse oximetry saturation(SpO_(2))/inspired oxygen concentration(FiO_(2))in predicting the prognosis of interstitial lung disease(ILD)complicated with acute respiratory failure.MethodsThis was a cohort study involving 101 acute respiratory failure patients with ILD who were hospitalized in the Respiratory Intensive Care Unit of Xuzhou Medical University Affiliated Hospital from February 2022 to November 2023 by non-random sampling method.They were divided into survival group(41 cases)and death group(60 cases)according to their survival status at 28 days of follow-up.The general information,clinical data,SpO_(2)/FiO_(2),arterial oxygen partial pressure(PaO_(2))/FiO_(2),and the Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore of the two groups were compared.The relationship between SpO_(2)/FiO_(2)and PaO_(2)/FiO_(2)was analyzed by Spearman′s correlation coefficient.The receiver operating characteristic(ROC)curve was drawn to compare the diagnostic efficacy of SpO_(2)/FiO_(2),PaO_(2)/FiO_(2),and APACHEⅡscore.Multivariate Cox regression analysis was used to analyze the influencing factors of poor prognosis in patients with acute respiratory failure complicated with ILD.The survival curve of patients with different SpO_(2)/FiO_(2)levels was drawn by Kaplan-Meier survival analysis,and the difference was compared by Log-rank test.ResultsIn the death group,there were 41 males and 19 females,with an average age of 71.0(64.0-79.0)years.In the survival group,there were 22 males and 19 females,with an average age of 70.0(63.5-81.5)years.The SpO_(2)/FiO_(2)([160.07±59.60]vs[224.05±63.13])and PaO_(2)/FiO_(2)(137.00[106.50,201.75]mmHg vs 206.00[155.00,253.50]mmHg,1 mmHg=0.133 kPa)in the death group were significantly lower than those of the survival group(P<0.001).The death group had a significantly higher APACHEⅡscore than that of the survival group([19.18±5.85]points vs[14.56±3.69]points,P<0.001).There was a linear correlation between SpO_(2)/FiO_(2)and PaO

关 键 词：肺疾病 间质性 呼吸功能不全 预后 脉搏血氧饱和度 动脉血氧分压 吸入氧浓度 

分 类 号：R563.8[医药卫生—呼吸系统]